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Bleeding problems

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Some cancers and cancer treatments may cause changes in the body’s normal mechanisms to control bleeding (Low blood cell counts: Side effect of cancer treatment.1 Cancer treatment can temporarily lower the platelet count. These are blood cells that help clot the blood.1 If the platelet count is low, the person may be at risk for significant bleeding from very small injuries. Alternatively, sometimes the blood becomes too thick and clots excessively.1 Blood clots may collect in the lower legs or travel to body organs such as the brain, heart and lungs.

Vocational implications

A patient at risk for bleeding problems should avoid activities that can result in hemorrhage if they are injured in falls and other traumatic injuries. Blood clots occur most typically in certain types of cancer, in actively growing cancers and in individuals whose mobility is limited. Risk can be reduced by drinking lots of fluids and, if sitting for long periods, getting up and walking around.

What patients can do

Teach patients who are at particular risk for bleeding problems ways they can cope. They will not necessarily feel any differently if their platelet count has dropped but can learn some of the warning signs of a low platelet count (thrombocytopenia). These include:

  • easy bruising
  • small red spots (petechiae) on the arms and legs
  • bleeding from the gums when brushing teeth
  • unusually long or heavy menstrual periods
  • sudden onset of severe headache, with or without limb weakness

Signs of blood clots:

  • swelling of the lower legs, often on one side only, with or without pain in the leg muscle or under the knee
  • difficult or painful breathing
  • pink secretions from the lungs when coughing

Steps to keep the body healthy when the patient has a low platelet count, recommended by the Mayo Clinic’s Low blood cell counts: Side effect of cancer treatment:1

  • Eat a balanced diet.
  • Avoid injuries.
  • Avoid germs.
  • Rest.

Job accommodations

Modify work tasks:

  • Ask that others do tasks that involve a higher risk of physical injury.
  • Request safety equipment suited to the job.

Modify the work environment to reduce risk of falls:

  • Remove clutter, loose cords and wires from the workspace.
  • Ensure adequate lighting in all workspaces.
  • Keep floors free from spilled liquid.
  • Eliminate uneven flooring surfaces.

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